Additional Value of Optical Coherence Tomography-Derived Virtual Flow Reserve for Percutaneous Coronary Intervention Guidance

Background: The combination of imaging and physiology could provide the best guidance for complex and high-risk interventional procedures (CHIP). Aims: The objective of the present study is to evaluate the difference in percutaneous coronary intervention (PCI) planning in CHIP patients between angiography, angiography-derived fractional flow reserve (FFR), and the combination of imaging and physiology by means of optical coherence tomography plus virtual flow reserve (OCT-VFR). Secondary objectives were to evaluate disease pattern, virtual stent length, and RVD according to the different plans. Methods: Among patients included in the AQVA-I and II trials, we selected those receiving OCT (n = 114). Physiology reconstruction based on OCT traces was obtained in 97 patients. One operator, blinded to the actual procedural plan and to post-PCI result, planned the procedure according to angiography, angiography-derived FFR, OCT, and OCT-VFR. Results: OCT-VFR plan was different compared to angiography and angiography-derived FFR plans in 48% and 30% of the cases, respectively. OCT-VFR plan was also different from OCT plans in 25% of the cases, mainly because of a different disease pattern leading to shorter treatment. Pattern of disease was more frequently focal in the angiography-derived FFR plan if compared to OCT-VFR plan (p < 0.01). Stent length was different across different plans (p for trend < 0.001) with angiography-derived FFR with the shortest and OCT with the longest, respectively. Conclusions: OCT-VFR provided a different PCI plan than both angiography and angiography-derived FFR in more than one-third of the cases. If compared to OCT alone, the OCT-VFR plan was significantly shorter in terms of stent length. Trial Registration: ClinicalTrials.gov NCT05658952, NCT04664140.